Influenza Outbreak of 1918-1919

by Steve Case, revised by Lisa Gregory, 2010
NC Government and Heritage Library

See also: NC and Influenza (WWI); Public Health; Infectious Diseases

Health Bulletin cartoonFrom the Spring of 1918 through early 1919, as nations experienced the upheaval of World War One, an influenza pandemic ran through North Carolina. In April 1919, Dr. William Rankin, the Secretary of the State Board of Health and a noted proponent of health education, reported the death of over 13,600 North Carolinians from influenza, and estimated that approximately 1,000,000 of North Carolina's 2.5 million inhabitants had caught the disease. Nationally, the disease killed around 700,000, and some estimates suggest anywhere from 50 to 100 million died worldwide.

Known alternately as "the grippe," the "Spanish flu," and the "Spanish lady," the influenza A strain from this pandemic was particularly virulent, hitting the United States in multiple waves. There were a number of complicating factors that influenced the spread of the epidemic. Coming as it did during the height of the United States' involvement in World War One, such measures as the state took to combat the flu were often overshadowed by the patriotic fervor accompanying the war. In addition, the cause of the disease was unknown, and many hesitated even diagnosing it as influenza. Other diseases, like typhoid fever and tuberculosis, were affecting the state at the same time. North Carolina, along with the rest of the nation, was slow to respond with basic measures like temporary hospitals and quarantine areas and relied on volunteers to treat the sick.

The pandemic appears to have struck earliest in Wilmington (Cockrell 311). Thereafter, information from military camps across the state documents the rise and fall of flu. Camps within North Carolina (Greene, Polk, Bragg) as well as those in South Carolina (Sevier, Jackson), to which many North Carolinians were sent for basic training, supplied statistics to the United States Public Health Service, which were compiled in weekly Public Health Reports. Also included in the reports were articles on treatment, court cases, analyses, and telegraphic reports from other countries.

As the pandemic subsided, new hospitals were built around the state to make up for the lack of facilities during the pandemic. The government and those in the medical field recognized and promoted the importance of health education, both for the general public and health professionals. The staggering death toll and the degree to which the medical community struggled to deal with the virulent disease ended up being a "modernizing factor on the state's social health services" (Cockrell 311).

References and additional resources:

Cameron, Annie Sutton. 1919. A record of the war activities in Orange County, North Carolina. 1917-1919. Call #566. Manuscripts Dept. Southern Historical Collection, UNC-Chapel Hill.

Cockrell, David L. 1996. "'A blessing in disguise': The influenza pandemic of 1918 and North Carolina's medical and public health communities." North Carolina Historical Review 73(3): 309-27. 

The deadly virus: The influenza epidemic of 1918. National Archives and Records Administration.

Google Flu Trends.

North Carolina and the "Blue Death": The flu epidemic of 1918. LearnNC.

Influenza 1918. American Experience series, PBS.

Influenza digital archive. University of Michigan Medical School.

Influenza documents from the NC Digital Collections.

Taubenberger, Jeffrey K. and David Morens. 2006. "1918 influenza: The mother of all pandemics." Emerging Infectious Diseases

Image credit:

Detail from "The way North Carolinians do it at home." October 1919. The Health Bulletin, Vol 34, Issue 10.,285771



My father, Benjamin Hartwell Boyd, was from Hartford, AL. He started college in Sept. 1918 as a freshman at Davidson College. He told me in the 1960's that shortly after his arrival, several students became ill with the Spanish Flu. He was lucky and went to stay in the home of a professor whose family was spared the flu. Unfortunately, his roommate caught the flu and died. My extended family includes over a dozen graduates of Davidson. We are interested to know if this legend is true. In other words, did students at Davidson die from the Spanish Flu?
Thank you.
Sara Moore
Jacksonville, FL


Dear Sara,

Thanks for visiting NCpedia and asking your question.  By separate email, I am going to connect with librarians at the Government and Heritage Library at the State Library of North Carolina.  They will help direct you to the appropiate agencies and information resources for your question. 

Carla Morris, Government and Heritage Library


“Other diseases, like typoid fever and tuberculosis, were affecting the state at the same time.” Might be a “typho” in the above article. Fine article, notwithstanding.


Thank you for the information as well as the excellent wordplay. Change has been made.

Mike Millner, NC Government & Heritage Library


Hello, I am doing research on Fort Caswell, NC. I would like some help in finding out the number of deaths and number of sick from the pneumonia during the 1917 thru 1919. Also was there a grave yard located on Fort Caswell, NC?


NCpedia also has entries on Fort Caswell and the Influenza Outbreak of 1918-1919. The latter explains that: "... information from military camps across the state documents the rise and fall of flu. Camps ... supplied statistics to the United States Public Health Service, which were compiled in weekly Public Health Reports."

These public health reports may have the information you seek.

Try contacting Fort Caswell (currently owned by the North Carolina Baptist Assembly) directly for information :

You can also search our digital collections for information on the Fort from World War I:

Mike Childs, NCpedia, N.C. Government & Heritage Library.


How can I find out if two relatives died of flu or TB in Connecticut between Sept 1918 and Dec 1919. Clare, in Cork, Ireland.

Comment Response:

Thanks for posting in NCpedia about the Flu Outbreak. I am forwarding your question to Reference Services; contact information for them can be found at Someone in Reference Services will be in touch with you soon about your inquiry. Good luck in your research!


Emily Horton,  Government & Heritage Library

Add a comment

PLEASE NOTE: NCpedia will not publish personal contact information in comments, questions, or responses. If you would like a reply by email, please note thats some email servers are blocked from accepting messages from outside email servers or domains. These often include student email addresses from public school email accounts. If you prefer not to leave an email address, check back at your NCpedia comment for a reply. Please allow one business day for replies from NCpedia. Complete guidelines are available at